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FOR OFFICE USE: <br /> ,APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------- <br /> (Complete in Triplicate) Permit No. <br /> ---------=----------------------------------------------- 70 <br /> ---------------------------------------------------- <br /> ---- This Permit Ex fres 1 Yehr From Date Issued Date Issued ---____"__._._ <br /> Application is hereby made to the San Joaquin Local Health District for a permit construct and install the work herein <br /> described. This application is made in compliance wit County Ordinance <br /> No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION __ ,_.__f?733 --------- <br /> ------ ---------------CENSUS TRACT --SIC-_----------- <br /> Owner's Name-'---- -=----- - -- - - -- - - --- -'"=`-'-------------- `--=�'=� --------- ---- ------------------------------------ <br /> s <br /> Address -----=- - ---------f a --------- � C Y <br /> 4 = <br /> Contractor's Namc ------------ ----- ------ --------License #199V.;5V-------- Phone d_7 <br /> Installation will sewe7" --�'Residenze Apartment House,❑•Commercial:❑Trailer Court :0 <br /> Motel ❑Other ---- =i---- '`----------`------ <br /> Number <br /> ---Number)of living.units:____. _____ Number of:bedrooms .-Garbage Grinder _________ _ Lot Si e -.��.�____15___�>T ------------- r. <br /> I y- / <br /> Private <br /> Water Supply: Public System -and nam,e�---:-----r --------------- . . ---"K/-- ❑ I <br /> Characte lof soil to a depth of 3 feet: Sand'E] Silt E] Clay El Peat❑ Sandy Loam ❑ flay Loam ❑ r <br /> Hardpan ❑ Adobe -Fill Material A If yes;•type----:---``- ,----_______ <br /> (Plot plan,f showinge'size of lot, location of system -in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW _T (No seepage pit,permitted ited ifpublic availablesewer <br /> er is within 200 feet, <br /> SEPTIC TANK � � 7 { Liquid De <br /> PACKAGE pth _____ <br /> o. Compartments�?-�------- Type _ Material ---------­------ <br /> __ <br /> �.f. <br /> ,- <br /> _-_-- <br /> s <br /> Distance-to—nearest.Well- -_-____-____-____ _____________Foundation --- ---------- Prop, Line __, �:___--.__ <br /> LEACHING LINE � No. of Lines -.,----� --- -- Length of ac line---- ��_._._____ Total Length ---f_7Q._._ ____ f <br /> rr _Depth Filter Material E--`- =- ---� �-.--.------ r` <br /> Box -----✓ Type Well <br /> Material - -------------- <br /> 'D' --'-- � ----------------- <br /> Yp <br /> Distance to nearest. W '______---_ Foundation' ----- ----- Property,line ______________ <br /> p _ Rock filled Yes ` No `,�d <br /> SEEPAGE PIT � Depth __��___-- -- Diameter __33__ __. Number --:-------'•-- ------- ----- i❑ <br /> _ ','k'- �, •�`% %rte <br /> Water Table Depth ------------------------------------------------Rock`Size Xl-- Si ./` / + I <br /> � <br /> 31 <br /> Distance to nearest: Well ---t___�._____________________________Foundation _' i�____ Prop. Line ............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit =-- ------------------------ -- Date -------------------`•_--------------) f+ <br /> Septic Tank (Specify Requirements) ------------------- ---- '---------------------------:------------- , <br /> ----------------------- - ------- <br /> Disposal Field {Specify Requirements) --------------------------------------------------------- -------------------------- ------------------------------------------ <br /> - - <br /> 4 <br /> ________________---------_-------------------------------------_________________________________________--__________---i--_____________-_______________------_-___________________-- _____ <br /> , (Draw existing and required additiononreverse side) t <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ........ ----------- Owner + <br /> BY ------- - -------------------------------------------------------- <br /> ------- ------------- ---_----------------------- Title ------ K �_ .----------- <br /> [If other a owner <br /> N•. FOR_60ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -. DATE .- �a'------------------------------- <br /> BUILDING PERMIT ISSUED - --_-- DATE --------- -- ------------- <br /> ADQITIONAL COMMENTS ----- <br /> __-_. __ �.____. ____ . <br /> .-------------------------------- ------- ? A -4/ ---- 3. .x.,5-------�._�,------- ---3---? -- = <br /> ----------------------------------- --------- -------------------------------------------------------------------- ---------------------------------------------------------------------------- <br /> --------------- -------------- --- ---- ---------------------------------- <br /> Final <br /> - <br /> --------- ------------- ----------------- ------ ----------- ---- ---------- <br /> Final Inspection by: � ----------------- ------- -- ---------- <br /> SAN <br /> -------- Date i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />